scholarly journals The far-lateral approach: destruction of the condyle does not necessarily result in clinically evident craniovertebral junction instability

2016 ◽  
Vol 125 (1) ◽  
pp. 196-201 ◽  
Author(s):  
Ehab Shiban ◽  
Elisabeth Török ◽  
Maria Wostrack ◽  
Bernhard Meyer ◽  
Jens Lehmberg
Keyword(s):  
Extent Of Resection ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Occipitocervical Fusion ◽  
Anterior Portion ◽  
Far Lateral Approach ◽  
Clinical Instability ◽  
Craniocervical Instability ◽  
Far Lateral

OBJECT Far-lateral or extreme-lateral approaches to the skull base allow access to the lateral and anterior portion of the lower posterior fossa and foramen magnum. These approaches include a certain extent of resection of the condyle, which potentially results in craniocervical junction instability. However, it is debated what extent of condyle resection is safe and at what extent of condyle resection an occipitocervical fusion should be recommended. The authors reviewed cases of condyle resection/destruction with regard to necessity of occipitocervical fusion. METHODS The authors conducted a retrospective analysis of all patients in whom a far- or extreme-lateral approach including condyle resection of various extents was performed between January 2007 and December 2014. RESULTS Twenty-one consecutive patients who had undergone a unilateral far- or extreme-lateral approach including condyle resection were identified. There were 10 male and 11 female patients with a median age of 61 years (range 22–83 years). The extent of condyle resection was 25% or less in 15 cases, 50% in 1 case, and greater than 75% in 5 cases. None of the patients who underwent condyle resection of 50% or less was placed in a collar postoperatively or developed neck pain. Two of the patients with condyle resection of greater than 75% were placed in a semirigid collar for a period of 3 months postoperatively and remained free of pain after this period. At last follow-up none of the cases showed any clear sign of radiological or clinical instability. CONCLUSIONS The unilateral resection or destruction of the condyle does not necessarily result in craniocervical instability. No evident instability was encountered even in the 5 patients who underwent removal of more than 75% of the condyle. The far- or extreme-lateral approach may be safer than generally accepted with regard to craniocervical instability as generally considered and may not compel fusion in all cases with condylar resection of more than 75%.

Comparison of the Far Lateral and Extreme Lateral Variants of the Atlanto-occipital Transarticular Approach to Anterior Extradural Lesions of the Craniovertebral Junction

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 662-675 ◽  
Author(s):  
Masatou Kawashima ◽  
Necmettin Tanriover ◽  
Albert L. Rhoton ◽  
Arthur J. Ulm ◽  
Toshio Matsushima
Keyword(s):  
Vertebral Artery ◽  
Anterior Part ◽  
Cerebrospinal Fluid Leak ◽  
Craniovertebral Junction ◽  
Lateral Approach ◽  
Sternocleidomastoid Muscle ◽  
Transoral Approach ◽  
Microsurgical Anatomy ◽  
Far Lateral Approach ◽  
Far Lateral

Abstract OBJECTIVE Managing lesions situated in the anterior aspect of the craniovertebral junction (CVJ) remains a challenging neurosurgical problem. The purposes of this study were to examine the microsurgical anatomy of the anterior extradural aspect of the CVJ and the differences in the exposure obtained by the far lateral and extreme lateral atlanto-occipital transarticular approaches. The far lateral approach, as originally described, is a lateral suboccipital approach directed behind the sternocleidomastoid muscle and the vertebral artery and just medial to the occipital and atlantal condyles and the atlanto-occipital joint. The extreme lateral approach, as originally described, is a direct lateral approach deep to the anterior part of the sternocleidomastoid muscle and behind the internal jugular vein along the front of the vertebral artery. Both approaches permit drilling of the condyles at the atlanto-occipital joint but provide a different exposure because of the differences in the direction of the approach. METHODS Fifteen adult cadaveric specimens were studied using a magnification of ×3 to ×40 after perfusion of the arteries and veins with colored silicone. The microsurgical anatomy of the extradural aspects of the CVJ and the two atlanto-occipital transarticular approaches were examined in stepwise dissections. RESULTS The far lateral atlanto-occipital transarticular approach provides excellent exposure of the extradural lesions located in the ipsilateral anterior and anterolateral aspects of the extradural region of the CVJ. The extreme lateral atlanto-occipital transarticular approach provides excellent exposure, not only on the side of the exposure, but also extending across the midline to the medial aspect of the contralateral atlanto-occipital joint and the lower clivus. CONCLUSION The far lateral and extreme lateral variants of the atlanto-occipital transarticular approach provide an alternative to the transoral approach to the anterior extradural structures at the CVJ. Compared with the transoral approach, both approaches provide a shorter operative route, avoid the contaminated nasopharynx, reduce the incidence of cerebrospinal fluid leak, and are not limited laterally by the atlanto-occipital joint.

scholarly journals Unilateral extended suboccipital approach for a C1 dumbbell schwanoma

2015 ◽  
Vol 22 (1) ◽  
pp. 38-42
Author(s):  
R.M. Gorgan ◽  
Angela Neacşu ◽  
A. Giovani
Keyword(s):  
Vertebral Artery ◽  
Fibrous Tissue ◽  
Cranial Nerves ◽  
Gain Control ◽  
Complete Removal ◽  
Craniovertebral Junction ◽  
Lateral Approach ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Lower Cranial Nerves

Abstract Craniovertebral junction tumors represent a complex pathology carrying a high risk of injuring the vertebral artery and the lower cranial nerves. Dumbbell C1- C2 schannomas are very rare tumors in this location. We present a case of a 66 years old male accepted for left laterocervical localized pain, headache and vertigo, with a large C1 dumbbell schwannoma extending in lateral over the C1 arch and displacing the C3 segment of the vertebral artery superiorly and anteriorly. Complete removal of the tumor was achieved using a far lateral approach. The approach is discussed with focus on the vertebral artery anatomy as the approach should give enough space to gain control of the artery without creating instability. Safe removal of C1 nerve root schwanomas can be achieved even if they compress and displace the vertebral artery by entering a fibrous tissue plane between the tumor and the vertebral artery.

Far Lateral Craniotomy Closure Technique for Preservation of Suboccipital Musculature

2020 ◽  
Author(s):  
Muhammad Salman Ali ◽  
Stephen T. Magill ◽  
Michael W. McDermott
Keyword(s):  
Muscle Atrophy ◽  
Craniovertebral Junction ◽  
Contralateral Side ◽  
Lateral Approach ◽  
Senior Author ◽  
Occipital Condyle ◽  
Closure Technique ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Initial Results

AbstractThe far lateral approach is used for accessing pathology at the craniovertebral junction but can be complicated by postoperative suboccipital muscle atrophy. In addition to significant cosmetic deformity, this atrophy can lead to head and neck pain and potentially could contribute to cranio-cervical instability. To address this issue, the senior author began using a single myocutaneous flap without a muscle cuff and securing it directly to the bone using predrilled holes in the bone that resemble a chevron. The method is described and illustrated with an example case. Results from seven consecutive cases are reported since the technique was adopted. Muscle atrophy was measured by calculating area at the level of the occipital condyle and compared with the contralateral side. No significant differences were noted. In conclusion, we have found this to be an excellent closure technique and wanted to present our initial results for consideration by other skull base surgeons.

Microsurgical Excision of a Retro-odontoid Disc Hernia via a Far-lateral Approach: Successful Treatment of a Rare Cause of Myelopathy: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 54 (4) ◽  
pp. 1015-1018 ◽  
Author(s):  
Akira Matsuno ◽  
Michi Nakashima ◽  
Mineko Murakami ◽  
Tadashi Nagashima
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Lateral Approach ◽  
The Body ◽  
Cervical Cord ◽  
Resonance Imaging ◽  
Far Lateral Approach ◽  
Far Lateral

Abstract OBJECTIVE AND IMPORTANCE Among mass lesions causing myelopathy at the craniovertebral junction, retro-odontoid intervertebral disc hernias are very rare, with only four such cases reported in the literature. CLINICAL PRESENTATION A 77-year-old woman with this rare condition complained of motor and sensory disturbances in her extremities. Magnetic resonance imaging scans demonstrated an extradural mass lesion at the craniovertebral junction, compressing the lower medulla oblongata and the upper cervical cord posteriorly. INTERVENTION The lesion, which was partly mucinous cartilaginous and partly fatty and fibrous, was meticulously removed via a left far-lateral approach. The lesion was not neoplastic but was determined to be composed of fibrocartilaginous tissue, consistent with disc material. Postoperatively, the patient's sensory disturbances and motor weakness improved, and magnetic resonance imaging scans demonstrated marked shrinkage of the lesion. CONCLUSION Sagittal, T1-weighted, magnetic resonance imaging scans demonstrated a low-intensity band between the odontoid process and the body of the axis, which suggested a persistent cartilaginous band. Although upward migration of a herniated disc from the lower cervical spine and degeneration of retro-odontoid ligaments might be possible causes, a persistent cartilaginous band extending between the odontoid process and the body of the axis was considered to be the more likely origin of the retro-odontoid intervertebral disc hernia. Because the far-lateral surgical approach does not require retraction of the cervical cord and provides safe access to the lesion at the craniovertebral junction, it is a suitable surgical method for this condition.

The far lateral/combined supra- and infratentorial approach

1994 ◽  
Vol 81 (1) ◽  
pp. 60-68 ◽  
Author(s):  
Hillel Z. Baldwin ◽  
Christopher G. Miller ◽  
Harry R. van Loveren ◽  
Jeffrey T. Keller ◽  
C. Phillip Daspit ◽  
...  
Keyword(s):  
Brain Stem ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Direct Access ◽  
Content Type ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Lower Clivus ◽  
Neurovascular Structures

✓ A far lateral approach to the ventral brain stem, lower clivus, and anterior foramen magnum is described. Methods for further exposure of the superior petroclival region by incorporating a subtemporal craniotomy and posterior petrosectomy are also demonstrated. Eight sequentially illustrated steps depict this technique. The far lateral/combined supra- and infratentorial exposure is a comprehensive surgical approach that provides direct access to the entire anterior and lateral brain stem and craniovertebral junction. It minimizes brain-stem retraction and maximizes visualization of the neurovascular structures.

Endoscopic far-lateral approach to the posterolateral craniovertebral junction: an anatomical study

2012 ◽  
Vol 36 (2) ◽  
pp. 239-247 ◽  
Author(s):  
Fuminari Komatsu ◽  
Mika Komatsu ◽  
Antonio Di Ieva ◽  
Manfred Tschabitscher
Keyword(s):  
Anatomical Study ◽  
Craniovertebral Junction ◽  
Lateral Approach ◽  
Far Lateral Approach ◽  
Far Lateral
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